Lumbar Facet Joint Injections
A straightforward Guide for Patients
What is a Lumbar Facet Joint Injection?
The facet joints are small joints along the spine that help support movement, including bending, twisting, and standing. Like any joint in the body, they can develop arthritis or inflammation. When these joints become irritated, everyday movements may cause sharp or aching pain in the neck, mid back, or low back.
Each facet joint is connected to a tiny nerve called the medial branch nerve, which carries pain signals to the brain. When these joints are inflamed, this nerve can become overactive, leading to ongoing discomfort.
Facet joint injections are a minimally invasive option to help diagnose and treat pain coming from these arthritic or irritated joints.
Purpose of the Injection
A small amount of steroid (corticosteroid) and local anesthetic is placed directly into the inflamed joint. The steroid works to calm irritation, helping reduce pain and improve mobility.
What Happens During the Procedure
- You will lie comfortably in a sterile procedure room.
- The skin is cleaned and numbed with local anesthetic.
- Using live X-ray guidance, your provider carefully advances a small needle into the target facet joint(s).
- Once positioned, a small amount of medication is injected.
- Afterward, you will be monitored briefly in the recovery area before going home
The procedure typically takes about 15 minutes.
After the Injection
- Resume normal activities as tolerated.
- You may be asked to intentionally perform movements that usually increase your pain—this helps determine how effective the diagnostic portion of the injection is.
- Showering is allowed, but avoid baths, hot tubs, pools, or lakes for 24 hours.
- The care team will call you to check your symptoms and assess your response.
If Sedation Was Used
- No solid foods for 8 hours before the procedure.
- Clear liquids only up to 2 hours prior
(water, broth, clear juices without pulp, black coffee or tea). - No carbonated drinks, gum, candy, mints, or lozenges within 2 hours of your appointment.
- The care team will review your medications ahead of time and advise which to take.
- Not following these guidelines may require the procedure to be rescheduled.
Risks and Possible Side Effects
Facet joint injections are generally safe, but potential risks include:
- Temporary soreness at the injection site
- Minor infection (rare, under 1%)
- Increase in usual pain
- Bleeding, especially for patients on blood thinners
(Please inform your provider if you take warfarin, Plavix, aspirin, Xarelto, heparin, Lovenox, Brilinta, or similar medications.) - Very rare nerve injury
- Allergic reaction to local anesthetics, contrast dye, or steroid medication
- Inability to complete the injection due to anatomy or technical difficulty
Your provider will discuss your specific risks based on your health history.
Insurance Requirements
Insurance companies typically require certain steps before approving facet joint injections. These often include:
- A trial of physical therapy or provider directed Home Exercise Program (commonly for 6 weeks)
- Recent imaging, such as an X-ray or MRI
- Documentation showing inadequate improvement with conservative treatments
